Surface Warfare Medicine Institute
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Reference 1999 Surface Warfare Medicine Institute This booklet is designed to be useful to senior medical officers filling billets for CATF Surgeons and Officers-in-Charge of Fleet Surgical Teams. The information herein is derived from primary sources that are usually identified within the text. Non-referenced information is included in order to tap the experience of previous CATF Surgeons, and is so identified. Please send all correspondence concerning the content and style of this booklet to CAPT Jeffrey M. Young, MC, USNR, editor of the FMPR 1999, at the address below. All feedback is useful, and updates are scheduled for release annually. Surface Warfare Medicine Institute Building 500, Room 114 140 Sylvester Road Naval Submarine Base San Diego CA 92106-3521 (619) 553-0097 email: jmyoung@nmcsd.med.navy.mil Table of Contents Acronyms and Abbreviations 5 Bibliography 11 Blood Program 14 BUMED-14 Message 23 Casualty Receiving and Treatment Ships 24 CATF Surgeon Tasks 30 CLF Surgeon Tasks 32 Communications 33 Crisis Management 36 Echelons of Care 37 Fleet Surgical Teams 40 Glossary 45 Liberty & Working Port Visits 61 Mass Casualties 63 MEDEVAC 64 Medical Intelligence 65 Message Writing 72 MMART 74
M+1 CRTS Wartime Manning 77 Post-deployment Critiques 79 Pre-deployment Checklist (BUMED) 83 Pre-deployment Checklist (PHIBGRU 3) 85 Preventive Medicine 89 Quality Assurance/Credentials 94 Ship’s Compartment Numbering 97 Shipboard Protocols 98 Shipboard Resources Guide 100 Shipboard Terminology 102 Triage 103 Victims & Perpetrators & Alcohol Misuse 113 WWW & Telephone List 114
(NWP3, NWP4-02, JCS Pub 1, edited superset) Composite Warfare Commanders (Amphibious Ready Groups use an “L” designation instead of the leading “A”) AA Officer in Tactical Command AB Composite Warfare Commander AQ Command and Control Warfare Commander AW Anti-Air Warfare Commander AS Anti-Surface Warfare Commander AX Anti-Submarine Warfare Commander AP Strike Warfare Commander AR Air Resource Commander Alphabetical Listing A AAA arrival and assembly area AAAV advanced amphibious assault vehicle AABB American Association of Blood Banks ABFC advance base functional components ACE Air Combat Element ACLS advanced cardiac life support ACU Assault Craft Unit ADAL Authorized Dental Allowance List AECC aeromedical evacuation coordination center AELT aeromedical evacuation liaison team AFMIC Armed Forces Medical Intelligence Center AJBPO area joint blood program office ALCC airlift control center AMMAL Authorized Minimum Medical Allowance List AO area of operation; or Air Officer AOR area of responsibility AP armor-piercing ARG Amphibious Readiness Group ASBBC Armed Services Blood Bank Center ASBP Armed Services Blood Program ASD (HA) Assistant Secretary of Defense (Health Affairs) ASF aeromedical staging facility ASMRO Armed Services Medical Regulating Office ASWBPL Armed Services Whole Blood Processing Laboratory ATF Amphibious Task Force ATLS advanced trauma life support ATO air tasking order B BAS battalion aid station BB blood bank BDA battle damage assessment BES beach evacuation station BDC blood donor center BLDRPT blood report
BLS basic life support BPD blood product depot BSU Blood Supply Unit BTC blood transshipment center
C2 command and control C2W command and control warfare C4I command, control, communication, computer & intelligence CAS close air support CAT Crisis Action Team CATF Commander, Amphibious Task Force CBR chemical, biological, and radiological CBTZ combat zone CCO Combat Cargo Officer CE combat element CECO Combat Evacuation Control Officer CI counter-intelligence CIA Central Intelligence Agency CIC Combat Information Center CIFS close-in fire support CINC Commander in Chief CLF Commander, Landing Force CLZ LCAC landing zone CLZA LCAC landing zone support area CME continuing medical education CNO Chief of Naval Operations COC combat operations center COMMZ communications zone CONREP connected replenishment COMSEC communications security CONUS continental United States CP command post CPG Commander, Amphibious Group (ONE, TWO, or THREE) CPR cardiopulmonary resuscitation CRRC combat rubber raiding craft CRTF casualty receiving and treatment facility CRTS casualty receiving and treatment ship CSAR combat search and rescue CSO Chief Staff Officer (of amphibious squadron – PHIBRON) CSS combat service support CSSD Combat Service Support Detachment CSSE combat service support element CTF Commander, Task Force
DAS deep air support DASC Direct Air Support Center DET detachment DEW directed energy weapon (usually laser) DFAS Defense Finance & Accounting Service DIA Defense Intelligence Agency DNBI disease and nonbattle injury DOD Department of Defense DOS day of supply DOS Department of State (State Department) DOWW disease occurrence worldwide DRAW demonstration, raid, assault, withdrawal (amphib ops) DTF Dental Treatment Facility DTG date-time group (messages) DZ drop zone E EAF expeditionary airfield EEI essential elements of information ELINT electronic intelligence EMB embarkation EMCON emission control EMT emergency medical technician EPW enemy prisoner of war EW electronic warfare
FAC forward air controller FCC Federal Coordinating Center FCSSA force combat service support area FDC fire-direction center FEBA forward edge of the battle area FEMA Federal Emergency Management Agency FFA free-fire area FFP fresh frozen plasma FIC Fleet Intelligence Center FISC Fleet and Industrial Supply Center FLTCINC Fleet Commander in Chief FMF Fleet Marine Force FO forward observer FOD foreign object damage FORSCOM Forces Command FOS full operating status FP frozen platelets; or Family Practice FRBC frozen red blood cells FSCC Fire-Support Coordination Center FSSG Force Service Support Group FST Fleet Surgical Team G GCE ground combat element (MAGTF) GPMRC Global Patient Movement Requirements Center GPS global positioning system GQ general quarters GYN gynecology H H&S Headquarters and Service Company HANDSCO Headquarters and Service Company HCS Helicopter Coordination Section HDC Helicopter Direction Center HE high explosive HHS health service support HLSC Helicopter Logistics Support Center HNS host-nation support HSS helicopter service support HST Helicopter Support Team HUMINT human intelligence (vs. satellite imagery, radio signal, etc.) I IADS Integrated Air Defense System IAW in accordance with IDC independent duty hospital corpsman IDTC inter-deployment training cycle IFF identification, friend or foe IMA individual mobilization augmentee IP initial point IRR Individual Ready Reserve ISO International Standardization Organization ISIC immediate superior in command ITT Interrogator and Translator Team IV intravenous
JBPO Joint Blood Program Office JCS Joint Chiefs of Staff JDS Joint Deployment System JIC Joint Intelligence Center JMBO Joint Military Blood Office JMRO Joint Medical Regulating Office JOPES Joint Operations Planning and Execution System JORG junior officer requiring guidance (found on collar device) JTF Joint Task Force JULL Joint Unified Lessons Learned
KIA killed in action L LANTFLT Atlantic Fleet LCAC landing craft, air cushion (assault hovercraft) LF Landing Force LFOC Landing Force Operations Center LFSP landing force support party LOC line of communication LOD line of departure LOI letter of instruction LZ landing zone LZCP landing zone control party LZSA landing zone support area M MAGTF Marine Air-Ground Task Force MANMED Manual of the Medical Department MAO master-at-arms MAO Medical Administrative Officer MAP medical augmentation program MARDIV Marine division MARG Marine Amphibious Readiness Group MASF Mobile Aeromedical Staging Facility MCLL Marine Corps Lessons Learned M-Day mobilization day MEDCAPS medical capabilities study MEDEVAC medical evacuation MEF Marine Expeditionary Force MEF (FWD) Marine Expeditionary Force (forward) MEPES medical planning and execution system MEU Marine Expeditionary Unit MIA missing in action MMART Mobile Medical Augmentation Readiness Team MOPP mission-oriented protective posture MPF Maritime Pre-Positioning Force MRCC Medical Regulating Control Center MRCO Medical Regulating Control Officer MRS medical regulating system MSC Military Sealift Command; or major subordinate command MSOC Medical Support Operations Center MSR main supply route MTF Medical Treatment Facility MWR Morale, Welfare, and Recreation
NATO North Atlantic Treaty Organization NATOPS naval air training and operating procedures NBC nuclear, biological, and chemical NBG naval beach group NCA National Command Authority NDMS National Disaster Medical System NEO non-combatant evacuation operation NGO non-governmental organization NOFORN not releasable to foreign nationals NOTAM notice to airmen NSA National Security Agency NSN national stock number NWP Naval Warfare Publications O O&M operation and maintenance OAS offensive air support OBJ objective OCONUS outside continental United States OIC Officer-In-Charge OMFTS operational maneuvers from the sea OOTW operations other than war OPCON operational control OPLAN operational plan OPNAV Office of the Chief of Naval Operations OPNAVINST Naval Operations Instruction OPLAN operations plan OPORD operations order OPSEC operations security OPSUM operational summary (a daily report) OPTEMPO intensity of operations (e.g., low, high, extreme) OSC On-Scene Commander OTC Officer in Tactical Command OTH over-the-horizon P PACFLT Pacific Fleet PAHO Pan American Health Organization PCO primary control officer PCRTS primary casualty receiving and treatment ship PCS primary control ship PIM position of intended movement PMI patient movement item POE projected operational environment POL petroleum, oil, and lubricants POM program objective memorandum POM pre-overseas movement (as in POM period) POMI Plans, Operations, and Medical Intelligence Officer
QR quick reaction R RAS regimental aid station RBC red blood cells RCA riot-control agent ROC required operational capability ROE rules of engagement ROPU reverse osmosis processing unit RORO roll on - roll off ROS reduced operating status S SAM surface-to-air missile SAR search-and-rescue SATCOM satellite communications SCM ship’s cargo manifest SEAL sea-air-land SERE survival, evasion, resistance, escape SIGINT signal intelligence SLOC sea lines of communication SOP standard operating procedure SORM Standard Organization and Regulations Manual of the US Navy (OPNAV 3120.32 series) SORTS status of readiness and training SPLT shore party liaison team SPECAT special category STANAG standardization agreement STP Shock-trauma Platoon SURGCO Surgical Company
T-AH hospital ship TAML theater area (or Army) medical lab T/O table of organization TAC Tactical Air Commander TACAN tactical air navigation system TACC Tactical Air Control Center TACLOG Tactical-Logistical Group TACRON Tactical Air Control Squadron TAD Tactical Air Director TADC Tactical Air Direction Center TAO Tactical Air Observer TAOC Tactical Air Operations Center TAR tactical air request (net circuit) TEWA threat evaluation and weapons assignment TF Task Force TFMRS task force medical regulating system TOC Tactical Operations Center TOW tube-launched, optically-tracked, wire-guided (missile) TPFDD time-phased force and deployment data TPMRC Theater Patient Movement Requirements Center TRAC2ES TRANSCOM's regulating command and control evacuation system TRANSCOM Transportation Command TRAP tactical recovery of aircraft and personnel TYCOM Type Command
UDT Underwater Demolition Team UNREP underway replenishment USACOM United States Atlantic Command USAF United States Air Force
VERTREP vertical replenishment V/STOL vertical/short take-off and landing
WB whole blood WIA wounded in action WHO World Health Organization WMCCS worldwide military and command control system
FLEET MEDICINE BIBLIOGRAPHY The following publications/references are for use in planning and delivery of fleet medical support. Most of these are directly referred to in NWP4.02, Operational Medical and Dental Support. Those with a double asterisk (**) have associated Medical Correspondence Courses available through the Naval School of Health Sciences, Portsmouth (www-nshspts.med.navy.mil/corres/courses.htm) AFSC PUB 1 The Joint Staff Officer's Guide BUMED INST 3400.1 Series Operational Concept for Medical Support and Casualty Management in Chemical and Biological Warfare Environments BUMED INST 5360.1 Series ** (NAVEDTRA 13154) Decedent Affairs BUMED INST 5430.6 Series BUMED Organization Manual BUMED INST 6200 Series ** (NAVEDTRA 13112) General Information on Preventive Medicine BUMED INST 6300.2 Series Medical Services and Outpatient Morbidity Reporting System BUMED INST 6320.1 Series ** (NAVEDTRA 13113) Medical Regulating To and Within the Continental United States BUMED INST 6440.5 Series Medical Augmentation Program BUMED INST 6470.10 Initial Management of Irradiated or Radioactively Contaminated Personnel BUMED INST 6700.13 Series Authorized Medical / Dental Allowance List for U.S. Naval Vessels, Fleet Marine Force, and Other Elements of the Operating Forces BUMED INST 6700.36 Series Medical and Dental Equipment Maintenance and Repair Manual CINCPACFLT/CINCLANTFLTINST 6400.1 Series Mobile Medical Augmentation Readiness Team (MMART) Supply Block DA Pamphlet 27-1 Treaties Governing Land Warfare (Geneva Conventions) Defense Intelligence Agency Manual (DIA M) 59-1 Users Guide to Intelligence Dissemination / Reference Services DOD 6420.1 Series Organizational Functions of the Armed Forces Medical Intelligence Center DOD 6480.4 Series DOD Blood Program: Mobilization Planning Factors FMFM 1-8 / NWP 3-02.1 Ship to Shore Movement FMFM 4 Combat Service Support FMFM 4-50 Medical and Dental Support, U.S. Marine Corps FMFRP 0-14 Marine Corps Supplement to DOD Dictionary of Military and Associated Terms Joint Pub 1-02 DOD Dictionary of Military and Associated Terms Joint Pub 3-02 Joint Doctrine for Amphibious Operations Joint Pub 4-02 Doctrine for HSS in Joint Operations Joint Pub 4-02.1 JTTP for Health Service Logistics Support in Joint Operations Joint Pub 4-02.2 JTTP for Patient Evacuation in Joint Operations JOPES Volume I Joint Operations Planning and Execution System, Medical Planning and Execution System (MEPES; formerly JOPS) JOPS Volume I Joint Operation Planning System, Volume I (Deliberate Planning Procedures) JOPS Volume III Joint Operation Planning System, Volume III (ADP Support), Appendix U (Medical Planning Module (MPM) LFM 01 / NWP 22 / FM 31-11 / AFM 2-53 Doctrine for Amphibious Operations MCO 6700.2 Series Medical and Dental (Class VIII) Materiel for Support of the Fleet Marine Force NAVMAT P-4000-2 Logistic Reference Data NAVMED P-117 (Available on Virtual Naval Hospital (VNH) website and VNH CD) Manual of the Medical Department (MANMED) NAVMED P-5010 Preventive Medicine Manual NAVMED P-5041 The Treatment of Chemical Agent Casualties and Conventional Military Chemical Injuries NAVMED P-5047 Medical Support in Joint Operations (1972) NAVMED P-5052 Occupational and Environmental Health Prevention Treatment and Control of Heat Injury NAVMED P-5055 The Radiation Health Protection Manual NAVMED P-6530 Joint Blood Program Handbook, (ASBPO). January 1998 NAVMEDCOM INST S4812.1 Series Bureau of Medicine and Surgery NAVMEDCOM INST 6321.1 Series Bed Capacity and Licensed Beds NDP 1 ** (NAVEDTRA 13158) Naval Warfare NDP 2 ** (NAVEDTRA 13159) Naval Intelligence NDP 4 ** (NAVEDTRA 13158) Naval Logistics NWP 5 ** (NAVEDTRA 13160) Naval Planning NWP 6 ** (NAVEDTRA 13161) Naval Command and Control NWP 1-01 Naval Warfare Publication System NWP 1-02 Naval Supplement to the DoD Dictionary of Military and Associated Terms NWP 3-02.1 (Formerly NWP 22-3) / FMFM 1-8 Ship to Shore Movement NWP 4-02 ** (NAVEDTRA 13158) Operational Health Service Support NWP 4-02.1 ** (NAVEDTRA 13158) Health Service Support Logistics NWP 4-02.2 Patient Movement, Part A: Naval Expeditionary Forces Medical Regulating NWP 4-02.3 Planning, Operations, and Medical Intelligence, Part B: Medical Intelligence NWP 4-02.3 Planning, Operations, and Medical Intelligence, Part D: Operations Other than War NWP 4-02.4 ** (NAVEDTRA 13158) Deployable HSS Platforms, Part A: Fleet Hospitals NWP 4-02.4 Deployable HSS Platforms, Part B: Hospital Ships (T-AH) NWP 4-02.4 Deployable HSS Platforms, Part C: Forward Deployable Laboratory NWP 4-02.6 Clinical Specific HSS, Part C: Women's HSS in Operational Settings NWP 4-02.7 Occupational and Environmental Health Services Support NWP 11 Naval Operational Planning NWP 11-3 Characteristics and Capabilities of U.S. Navy Aircraft NWP 22-3 (Now NWP 3-02.1) Ship to Shore Movement (see also FMFM 1-8) NWP 65-0-1 Characteristics and Capabilities of U.S. Navy Combatant Ships OPNAV INST 1000.16 Series Manual of Navy Total Force Manpower OPNAV INST S 3061.1 Series The Navy Capabilities and Mobilization Plan OPNAV INST 3061.2 Series Total Force Manpower Mobilization Plan OPNAV INST 3100.6 Series Special Incident Reporting (OPREP-3) Procedures OPNAV INST 3120.32 Series Standard Organization and Regulations of the U.S. Navy OPNAV INST C 3501.2 Series Naval Warfare Mission Areas and Required Operational Capability / Projected Operational Environment Statement OPNAV INST C 3501.161 Series Projected Operational Environment (POE) and Required Operational Capabilities (ROC) for the T-AH 19 Class Hospital Ship OPNAV INST C 3501.176 Series Projected Operational Environment (POE) and Required Operational Capabilities (ROC) for the Combat and Communications Zone Fleet Hospitals and Rapidly Deployable Medical Facility (RDMF) OPNAV INST 4630.9 Series World Wide Aeromedical Evacuation OPNAV INST 5430.48 Series Office of the Chief of Naval Operations (OPNAV) Organization Manual OPNAV INST 6000.1 Series Management of Pregnant Servicewomen OPNAV INST 6530.4A Navy Blood Program OPNAV PUB 41P3 Series Table of Advance Base Functional Components with Abridged Initial Outfitting Lists SECNAV INST 1300.13 Series Navy Personnel Augmentation for the Fleet Marine Force (FMF) SECNAV INST 6600.1 Series Preventive Dentistry Program STANAG 2879 Principles of Medical Policy in the Management of a Mass Casualty Situation T-AH 19 Class Hospital Ship General Information Manual BLOOD PROGRAM (NAVMED P-6530 (1/98) & NWP4-02, App. K, edited superset) Frozen Blood Capabilities:
CONCEPT OF OPERATIONS Fluid and Blood Product Availability: Echelon I: Ringers Lactate and human albumin Echelon II: Ringers Lactate, human albumin, Group O red blood cells, liquid 3. Echelon III: Ringers Lactate, albumin (25 percent), red blood cells (liquid and frozen), fresh frozen plasma, platelet concentrate 4. Echelon IV: Ringers Lactate, albumin (25 percent), red blood cells (liquid and frozen), fresh frozen plasma, platelet concentrate Echelon V: Full range of resuscitation fluid and blood products Planning Factors and Issues: (DoD INST 6480.4) Four units of red blood cells per initial admission of each WIA and DNBI. One technician and two cell washers can deglycerolize 48 units of frozen blood cells in 24 hours. Assign staff for 12-hour shifts and 7-day work weeks. There is NO FROZEN BLOOD RESUPPLY TO SHIPS. Once frozen red cells are used by the LHDs, LHAs, and T-AHs, expect no additional frozen blood from the blood product depots (BPDs). Frozen blood is a transition into liquid blood; count on it for the first few days until the liquid blood pipeline is established. Hence, the early establishment of the pipeline of BSUs, BTCs, AJBPO, and JBPO is imperative. Walking Blood Bank: This is a tertiary source of blood (i.e., to be used only after liquid and frozen blood sources have been depleted (CNSL/P 6000.1 series). However, walking blood bank response should be checked frequently. Activate the Walking Blood Bank (or parts of it) during mass-casualty drills. EXTREMELY IMPORTANT: Meet OPNAV 6530.4A requirements: Save the donor card, a frozen plasma sample, and the correct donor / unit numbers. Report transfusions on ships to BUMED (code 273) for subsequent tracking in the future. This is a BIG ISSUE now, especially with HIV, HTLV, and hepatitis C. Prior to deployment, acquire all message “go-bys” for bringing blood to the ship if needed (a task for the senior advanced lab tech). BLOOD PROGRAM ACRONYMS AABB American Association of Blood Banks AJBPO Area Joint Program Office (see JBPO, below), Component Command level. ASBBC Armed Services Blood Bank Center. An armed service staffed blood bank with a Service assigned as executive agent, responsible for the collection, processing, and storage of blood products. The ASBBC provides blood products for medical treatment elements of two or more of the armed services. ASBP Armed Services Blood Program ASBPO Armed Services Blood Program Office Tri-service staffed, joint field operating Agency, with Army as DoD Executive Agent. CONUS based. The overall DoD manager for blood and BP (class VIIIB) during military contingencies and, when directed, for civilian relief efforts. ASWBPL Armed Services Whole Blood Processing Laboratory. Tri-service with USAF as Executive Agent. Shipment from CONUS blood banks to Unified Combat Command BTCs or TBTCs. BDC Blood Donor Center. Component staffed. Requires FDA license. BP Blood Products BSU Blood Supply Unit. Component staffed. Receives BPs from BTCs and/or TBTCs or BPDs; issues those products to MTFs in assigned area. BTC Blood Transshipment Center. USAF staffed. Middle man responsible to receiving, storing, re-icing, and shipping blood. See also TBTC (Transportable Blood Transshipment Center) BPD Blood Product Depot. Component staffed. Strategic storage of frozen BP in a Unified Combatant Command. DoD Blood Program equivalent to Pre-Positioned Force. JBPO Joint Blood Program Office. Tri-service staffed, overall joint BP management for Unified Combatant Commander. (cf: SBPO) SBPO Service Blood Program Office. Component staffed, Coordination and management of that Service’s Blood Program. TBTC See BTC above. USAF. Transportable to locations with minimal infrastructure. Blood Support Activities Blood Resources Management and Support Joint Blood Program Office - Each unified command has been requested by the Armed Services Blood Program Office to designate a joint health office to implement DoD blood program policies and coordinate the blood programs of the unified command components. The JBPO will be the single interface with the Armed Services Blood Program Office in CONUS. Normally, the JBPO will collocate with the Theater Patient Movement Requirement Center (TPMRC). The JBPO will redistribute blood among regions in the theater and will request blood supply from CONUS. The JPBO will submit a daily blood situation report to the Armed Services Blood Program Office during the contingency using the appropriate format (Annex A). Information copies will be provided to each AJBPO and other agencies as required. Area Joint Blood Program Office - Unified commands have been requested by the Armed Services Blood Program Office to establish AJPBOs as required. They will implement the unified command blood program policies, coordinate the blood programs of the unified command components within their area, and manage blood products in the assigned BTC. Normally, the AJPBO will collocate with the Area TPMRC. The AJPBO will redistribute blood among components in the theater or request blood supply from the JBPO. The AJBPO will submit a daily blood situation report to the JPBO using the appropriate format (Annex A). Information copies will be provided to each component blood products depot unit and other agencies as appropriate. Blood Transshipment Centers - The USAF operates the BTCs. The USAF is planning to staff and equip these centers to store and issue up to 3,000 units each of liquid and frozen blood products on a daily basis. Determining the numbers and locations of the centers is a responsibility of the unified command and will be adequate to support each unified command component’s blood requirements on an area basis. Normally, the Navy or Marine Corps will arrange transportation to obtain blood from the BTC for Navy or Marine Corps units. Blood issue to the Navy and Marine Corps will be based on a daily allocation system established by the theater JMBO. The allocations will be modified as required. Frozen Blood Depots - The Navy operates one frozen blood depot in Sigonella, Sicily, and one in Okinawa, Japan. These depots have the capability to store 40,000 and 10,000 units of frozen blood, respectively. Each depot has one Medical Service Corps officer, Naval Officer Billet Code 0866; one enlisted technician, Navy Enlisted Classification 8506; and four civilian technicians, GS-644-04/05. These depots will provide frozen blood products to appropriate medical platforms upon direction by the AJBPO. The Army is also planning to establish frozen blood depots to store a total of 75,000 units of frozen blood products. The USAF is planning to store 50,000 units of frozen blood in Armed Services Whole Blood Processing Laboratories in CONUS. Blood Supply Units - The Navy and Marine Corps will establish BSUs as recommended by the JBPOs. Personnel at these supply points will, upon direction by the AJBPO, arrange or provide transportation for blood products from the BTCs to the BSUs and then coordinate shipment to Navy or Marine Corps field medical units, Fleet Hospitals, and ships. The following units are likely to function as BSUs: Frozen blood depots. USMC units where medical personnel are responsible for coordinating blood and clinical fluids support. FSSG detachments in the theater of operations. Blood donor centers at Naples, Italy; Rota, Spain; and in the United Kingdom. Medical Field Refrigerator - A lightweight, refrigerated blood box (NSN 410-01-287-7111) operating from direct or alternating current, containing 30 to 50 units of red blood cells. It has been shipped to the field medical supply activities by the Defense Personnel Support Center. Frozen Blood Container - The USAF developed a shipping and storage container for frozen blood products to transport them without dry ice. It can be ordered through the local medical stock. The stock number is 814013571551 on the Management Data Listing. Blood Box Management - Whenever possible, blood will be transported from blood supply points in boxes provided by the intended recipient. When the recipient has no box, attempt will be made to return boxes used to ship blood to the blood supply point or to exchange empty for full boxes. Frozen Blood Management - Assure that Standard Operating Procedure (SOP) is clear on the new USAF frozen blood container and explains the proper handling of the eutectic solutions. To reuse the solutions, they must be COMPLETELY thawed to room temperature and then refrozen at –65C or lower. Communications - All blood reports and blood shipment reports are sent using standard Armed Services Blood Program Office voice, message, and/or computer-generated blood report formats. The US Message Text Format is the basis for voice and message blood reports. The Armed Services Blood Program Office plans to have the Defense Systems Support Command automate the ASBP blood banks by developing the Defense Blood Standard System. The Theater Army Medical Management Information System has been designated to automate Army activities in the theater and modernized to support the Navy Fleet Hospitals as the Fleet Hospital blood bank module. Any computer systems purchased for CONUS blood collection stations will be compatible with the Defense Blood Standard System, and computer systems purchased for OCONUS MTFs shall be compatible with the Theater Army Medical Management Information System. The Armed Services Blood Program Office requires that the Theater Army Medical Management Information System and the Defense Blood Standard System also be compatible. Walking Blood Bank - SOP will be clear that blood from walking donors is collected properly. OPNAV instruction require completion of donor cards, saving of frozen blood samples, and correct donor / unit numbers to identify the donor card, donor frozen sample, and unit number. This allows the donated units to be tested and “look-back” for HIV, HCV, etc., to be accurately accomplished. Pre-qualifying walking donors in CONUS military blood banks just prior to deployment is a method used by some deploying units. However, regardless of pre-qualification, SOP must be followed for each donated unit. BLOOD ISSUES ASHORE — LANDING FORCE Echelon I, Unit Corpsman and Battalion Aid Station Resuscitation fluids: Ringers Lactate, human albumin. Blood / blood products: None.
Resuscitation fluids: Ringers Lactate, human albumin. Blood / blood products: Frozen blood, Group O liquid blood
Resuscitation fluids: Ringers Lactate, human albumin . Blood / blood products: Liquid / frozen blood, fresh frozen plasma, platelet concentrate. Operational Aspects - The CATF Surgeon or CLF Surgeon will assess blood resources / requirements daily and report to the AJBPO. The CATF Surgeon will coordinate blood and fluid support for the medical battalion from the CRTS, using medical field refrigerators and standard blood boxes. When the CRTSs leave the amphibious ops area, the medical battalion must rely on the medical logistics company or the AJBPO for blood. If no liquid blood is available, blood may be harvested from LF personnel or from the ship’s crew (before leaving the amphibious ops area). Shock-Trauma Platoon - Each STP can draw 240 units of blood and can process and crossmatch 1,000 units. Each STP can store 120 units in field refrigerators. Occasionally, a STP may be augmented with a surgical support platoon, which has a blood bank capacity equivalent to that of a STP. Amphibious Assault - Personnel responsible for management of clinical fluids and blood products will report to the CATF Surgeon or LF Surgeon daily. Consider locating a clinical fluids squad with the Surgical company and a clinical fluids platoon with the Medical Logistics Company. These squads can thaw and wash frozen blood and receive and distribute liquid blood. Submit daily blood reports to the AJBPO. The CRTS will supply thawed and washed using standard blood boxes and medical field refrigerators. Frozen blood will be transported in the new shipping and storage containers for frozen blood. Prior to the CRTS leaving the amphibious ops area, or the blood supply aboard the CRTS being depleted, the CLF Surgeon will request more blood / blood products from the AJBPO. Surgical Company - If liquid or frozen blood is unavailable or unobtainable, each Surgical Company has the capability to draw 720 units and process and cross-match 3,000 units. Storage capability in current field refrigerators is 360 units. Organizational Aspects - Resuscitation fluids and blood products transported ashore will be handled by the STP, the evacuation platoon at the Beach Evacuation Station, the helicopter support team evacuation station, and medical personnel charged with coordinating blood / clinical fluids for the Surgical or Medical Logistics Company. The CLF Surgeon or representative will manage blood resources and requirements. If frozen blood is needed on the beachhead, deglycerolize it on the LHA / LHD, then ship it ashore. Transportation - Resuscitation fluids and blood products will be transported ashore primarily by helicopters dispatched to evacuate casualties. A secondary means is ground vehicle landing craft or amphibious landing craft. Transport of resuscitation fluids forward to regimental and BASs will be by any means available, depending heavily on vehicles used for medical evacuation. Additional delivery methods - Navy emergency air cargo delivery systems, low-altitude parachute extraction systems, and high-speed low-altitude - have been successfully tested and may be available. Blood products requested from and assigned by the AJBPO can be picked up or delivered by helicopter from the nearest BSU or BTC assigned by the AJBPO. BLOOD ISSUES AFLOAT Echelon II Resuscitation Fluids: Ringers Lactate, human albumin Blood / Blood products: Frozen / Liquid
Larger ships and CRTSs will possess the capability to process frozen blood products stored aboard those and other ships within the Task Force. For resupply, ships will contact the TF medical officer who will subsequently contact the AJBPO as needed. It is very important to identify blood resupply points during this communication. Smaller ships will rely on the larger ships and CRTS for blood support. Use the walking blood bank as a tertiary blood source when neither liquid red blood cells nor thawed and washed cells are available. Liquid blood will be transported to other ships in standard blood boxes with 14 lbs. of wet glistening ice or in medical field refrigerators. Frozen blood will be transported in the new shipping / storage container. One technician with two cell washers can deglycerolize 48 units of frozen red blood cells in 24 hours, staffing based on 12-hour / 7-day work week. Blood aboard ship will be managed by embarked medical personnel and transported by supply and logistics personnel. The Task Force medical officer will manage blood resources and requirements. Transportation Blood can be transported between ships by helicopter or high-line. Resupply of frozen or liquid blood from nearby blood supply points can be transported by helicopter. If distances are prohibitive, blood can be delivered by Navy emergency air cargo delivery system. THE BUMED-14 MESSAGE (Do Not Leave Homeport Without It) LT Youssef H. Aboul-Enein, MSC, USNR Mr. Jeffrey Stiech, BUMED 14 Every fiscal year BUMED-14 issues a message, Subj: FYXX CENTRALLY MANAGED ALLOTMENTS. This message contains accounting data that can be used for foreign hospitalizations, ambulance services, ancillary and non-medical attendant fees FOR ACTIVE DUTY ONLY. Use this message to pay all your foreign medical bills. The only requirement is that upon the completion of care you forward all copies of paperwork, medical records, and invoices to BUMED-14 (currently Mr. Jeff Stiech MED 14L, DSN 762-3577). This is important as it facilitates payment when the bill reaches DFAS (Defense Finance Accounting Service) and avoids embarrassment for your command. DO NOT DEPLOY WITHOUT THIS MESSAGE. Two additional POCs are Dwight Daniels, (202) 762-3565, DSN 762-3565, and Perwez Hashmi, (202) 762-3578, DSN 762-3578. Attention MRCOs: you may want to call Mr. Stiech to make sure your unit is an info addee to this valuable message. CASUALTY RECEIVING & TREATMENT SHIPS (NWP4-02, Section 5, edited subset) Amphibious Task Force CRTSs After troops debark for ship-to-shore movement, specific ships of the ATF are designated as primary CRTSs to provide Echelon II HSS to the landing force during amphibious operations. Primary CRTSs have laboratory (including blood) and radiology capability to support surgical suites. During amphibious ops, primary CRTSs are staffed as necessary to provide extensive trauma support. The ships normally designated as the primary CRTSs are the LHA, and LHD class amphibious assault ships. The CATF may designate amphibious ships as secondary CRTSs. These may include any class ship with the capability to receive and treat casualties, if appropriate medical materiel and personnel are available to provide resuscitative care. Ships normally designated as secondary CRTSs include LPD, LSD, LKA, LST, and LCC class ships. Download 0.74 Mb. Share with your friends:
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